Insurance Information

At Sunset Oral & Maxillofacial Surgery, we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. We will ask for your insurance information upon scheduling so that we may verify your benefits before your appointment as a courtesy to you. We ask that you please bring your insurance cards to your consultation to help expedite reimbursement.

Please note:Not all of our doctors are contracted with all of the above listed medical plans. Please call our office with any questions about which doctors participate with which plans.

As our nation’s health insurance industry continues to change we do our best to stay on top of the latest information. We are continuously working to improve our communication with insurance companies; however our office is considered a third party when it comes to the relationship with the insured party (subscriber) and the insurance company. The insurance companies have no responsibility to our office to quotes plan benefits accurately. They may still deny services for a variety of reasons including the basis of medical necessity, listed plan exclusions or benefits being maxed out at the time of service. We do suggest familiarizing yourself with your insurance benefits before receiving services. We want you to be well informed with your plan so that nothing comes as a surprise to you. If you have questions about your insurance plan please contact your insurance provider directly or let us know how we can assist you.

Understanding Insurance

What are UCR fee’s (Usual, Customary, or Reasonable Charges?

UCR charges are the maximum amount covered by a plan. These fees are determined and set by the insurance company. The term “UCR” can be misleading, because it makes it seem like the dentist or specialist is over charging for a service, however, these fees are frequently not in tune with current fees charged in a particular area, rise of inflation, a lack of fee review, and many other factors. Insurance companies are not required to disclose how they determine their UCR fees or how often they review them, thus frequently leaving a discrepancy between the amount paid and what the provider charges.

What will my insurance pay?

Insurance plans vary dramatically from patient to patient. The plan you are enrolled in will determine reimbursement rates, annual maximums, exclusions, frequency limitations, etc. These are all determined by your particular plan and are not determined by our office. It is important to remember that dental insurance plans are designed to assist with your dental care needs, rather than cover them completely.

Understanding Deductibles & Co-Payments

When reviewing your dental benefits it is important to remember the role of deductibles and co-pays in determining your benefits. Your deductible and co-pay amounts are always taken off the top of the charge and then the percentage that your insurance company pays for a particular procedure is then calculated out. For instance, assume you come in for an office visit and the charge is $200. Your particular plan has a $50 deductible and pays 80% of office visits. First, you would take $200 and subtract off the deductible of $50, leaving $150. The insurance company will then pay 80% of $150, which is $120. Therefore, you are responsible for the difference of $30 ($150-$120) plus the deductible of $50, leaving your out of pocket costs at $80. Of course, if the UCR fees are less than the office visit that was charged the out of pocket expense would be slightly higher.